Butthurt Form
When did this happen?
-
Month
-
Day
Year
Date
What time did the incident happen?
Hour Minutes
AM
PM
AM/PM Option
Where did this happen?
What is the nature of this butthurt?
Blog post
Forum or Message Board post
Twitter post
Facebook post
Chat room
Meme post
Video post
Website
Other
Kindly elaborate or provide more details about the incident
Please provide related links/URLs (post, comments, videos, etc.)
Did you cry?
Yes
No
Did you get depressed?
Yes
No
Are you having trouble sleeping because of the incident?
Yes
No
Was your job or work affected?
Yes
No
Do you need someone to talk to in order to share this?
Yes
No
Why are you filing this report?
I am offended
I am hurt
I am thin-skinned
I am cry baby
I am a wimp
I am a mama's boy/girl
Life is not fair
Other
Describe the person who caused this incident
What did you do after the incident?
I created a post about the incident in social media accounts
I replied to the post
I blocked him/her
I searched online about him/her
Nothing
Other
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Should be Empty: